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Diaper Dermatitis and Diaper Rash

Diaper rash is one of the most common skin disorders, occurring in 50% of infants, with 5% having severe rash. The peak incidence is between 9 and 12 months.

Breast fed infants have fewer diaper rashes than formula-fed infants. The frequency and severity of diaper dermatitis are significantly lower when the number of diaper changes per day is eight or more. Superabsorbent disposable diapers significantly reduce the severity of diaper rash when compared to cloth diapers diaper rash.

Dermatoses related to diaper wearing

Irritant diaper dermatitis is the most common form of diaper dermatitis. It is accentuated on the convex areas, including the buttocks, lower abdomen, genitalia, and upper thigh, sparing the creases. It varies in severity from mild erythema (with or without scales) to papules and

Management

Irritant diaper dermatitis can best be prevented by keeping the skin in the diaper area protected from urine and feces by increasing the frequency of diaper changes and by

A low_potency corticosteroid ointment ( hydrocortisone 1%) should be applied four times daily with

Thickly applied barrier creams, such as A&D ointment, zinc oxide pastes or Vaseline, may be 

Candidal diaper dermatitis

Candidal diaper dermatitis is characterized by beefy red plaques with white scales and satellite papules and pustules, which almost always involve the inguinal creases. It often develops after an episode of diarrhea or after use of antibiotics. KOH scrapings may

Candidiasis is treated with topical nystatin (Mycostatin), clotrimazole ( Lotrimin), miconazole ( Monistat), or ketoconazole ( Nizoral) applied 3-4 times daily. Hydrocortisone 1% ointment may help decrease erythema and inflammation and can be

Oral nystatin ( Mycostatin) suspension, four times a day, should be used if repeated episodes of candidal dermatitis occur. The mother should be evaluated for candidal infection of the nipples or genital tract. In severe cases, oral fluconazole 3 mg/kg per day as a pulse dose weekly x 2 or for a short course of 5 to 7 days may be of benefit.